Annals for Educators - March 2023
Authors: Christine Laine
Journal: Annals of Internal Medicine (2023)

Web ExclusivesMarch 2023Annals for Educators - March 2023FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202303210 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsImplantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance ImagingData on the ability of non–MRI-conditional implantable cardioverter-defibrillators (ICDs) to terminate arrhythmias after MRI have been limited. This study examines whether non–MRI-conditional ICDs have preserved shock function of arrhythmias after an average of 2 years of follow-up after MRI.Use this article to:Review the indications for ICD placement.Invite a cardiologist to your session to teach about the different types of ICDs and how to tell whether a patient has a device that is non–MRI-conditional.Discuss how this article could be helpful in assuring patients with ICDs that it is OK for them to get an MRI if they need one.Long-Term Changes in the Size of Pituitary MicroadenomasPituitary lesions found on brain imaging that is done for other purposes are often called “incidentalomas,” and most are microadenomas with diameters less than 10 mm. Little is known about how stable these microadenomas are and how often they should be imaged. This article provides new information about the stability of pituitary microadenomas.Use this article to:Invite a radiologist to your session to review pituitary microadenomas detected on MRI.Discuss the currently recommended surveillance strategy for pituitary incidentalomas and whether the results of the study suggest that changes in the surveillance recommendations are indicated.Invite an endocrinologist to your session to review the indications for intervention of a pituitary microadenoma.Risk Model–Based Lung Cancer Screening. A Cost-Effectiveness AnalysisSelecting Candidates for Lung Cancer Screening: Implications for Effectiveness, Efficiency, Equity, and ImplementationThis study showed that risk model–based lung cancer screening approaches are more cost-effective than selecting people by using the 2021 categorical age smoking criteria from the U.S. Preventive Services Task Force (USPSTF). The accompanying editorial discusses why we cannot assume model results will be replicable in clinical practice and the need to overcome barriers to balancing tradeoffs in effectiveness, efficiency, and equity.Use this article and the editorial to:Review the current USPSTF recommendations for lung cancer screening.Discuss the potential harms associated with lung cancer screening.Invite a pulmonologist to your session to discuss the appropriate next steps if a pulmonary lesion is identified during lung cancer screening of an asymptomatic patient.Ask your learners to discuss what cost-per-QALY threshold policymakers should use to identify a “cost-effective” intervention.Planning for Mpox on a College Campus: A Model-Based Decision-Support ToolIn the current global outbreak of mpox, it is important to model how human-to-human transmission could occur in congregate settings and how to mitigate spread. This study estimated the likelihood of an mpox outbreak and the potential effect of mitigation measures in a residential college setting.Use this article to:Review the clinical presentation of mpox.Discuss the indications for vaccination to reduce the risk for mpox and the procedures for arranging vaccination at your institution.Review pharmacologic therapy for mpox and the procedures for arranging therapy at your institution.Discuss how you would counsel a patient to reduce the risk for transmission of infection to others.Symptom and Viral Rebound in Untreated SARS-CoV-2 InfectionThere have been reports of rebound of SARS-CoV-2 and symptoms after receipt of nirmatrelvir–ritonavir for treatment of COVID-19. Using prospectively obtained data from patients receiving placebo in a large COVID-19 “platform” trial, this study investigated the natural history of rebound in the absence of antiviral therapy.Use this article to:Review the indications for using nirmatrelvir–ritonavir to treat COVID-19. This article will help guide the discussion. Ask your learners whether they think this study provides convincing evidence that rebound is a feature of COVID-19 and not something associated with treatment with nirmatrelvir–ritonavir.Discuss how the findings of this study could be used to help convince patients to accept treatment if they are reluctant to take nirmatrelvir–ritonavir because they have heard stories about rebound.Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes. A Systematic Review and Meta-analysis of Individual Participant Data From 3 Randomized Clinical TrialsPreventing Type 2 Diabetes With Vitamin D: Therapy Versus SupplementationThis systematic review and individual patient data meta-analysis synthesized 3 randomized controlled trials of vitamin D to prevent diabetes in persons with prediabetes. The accompanying editorial discusses the findings and emphasizes the important differences between supplementation and therapy.Use this article and the editorial to:Watch the brief video summarizing the systematic review with your learners. Review the definition of “prediabetes”.Discuss the appropriate dose of vitamin D supplementation.Review the important difference between supplementation and therapy that the editorial highlights.Ask your learners whether the findings of this review motivate them to recommend vitamin D to patients with prediabetes.Reproductive Health Policy in the United States: An American College of Physicians Policy BriefSince the U.S. Supreme Court decision in Dobbs v Jackson Women's Health Organization, some state governments have imposed stringent restrictions on abortion, whereas others have sought to protect access. In this paper, the American College of Physicians updates its previous positions to reflect this new reality and offers recommendations to promote equitable access to reproductive health care services and safeguard maternal health.Use this article to:Review the current policies on contraception and abortion in the state where your learners practice.Ask your learners whether the current policies would make them hesitant to refer a patient for abortion.Review the options for referral of a patient for abortion at your institution.Discuss the potential implications of state restrictions on reproductive health care for other health situations. This commentary, this commentary, and this commentary can help prompt discussion. Recommended Adult Immunization Schedule, United States, 2023This article provides immunization recommendations from the Advisory Committee on Immunization Practices (ACIP) for adults aged 19 years or older. The purpose of the immunization schedule is to consolidate and summarize updates to ACIP recommendations on vaccination of adults and to assist providers in implementing current ACIP recommendations.Use this article to:Invite a colleague from nursing to your session to demonstrate the proper technique for administering an intramuscular vaccine.Review the changes in the ACIP vaccine recommendations between 2022 and 2023.Ask your learners to share strategies they find helpful in discussing vaccination with patients who are hesitant to receive it. This article may help to stimulate the discussion. Public HealthFirearm Injury: An Escalating Health CrisisAn estimated 50 000 people in the United States lost their lives to guns in 2021. An infectious organism responsible for that many deaths would clearly be considered a public health threat, and that is why the American College of Physicians sees gun injury as a public health issue. Reducing the negative impact of guns on the health of the U.S. public requires multidisciplinary efforts involving government, law enforcement, gun manufacturers, and others; health care professionals also have an important role. On 11 January 2023, Annals of Internal Medicine and the American College of Physicians gathered a panel of experts to discuss what health care professionals can do to reduce the adverse effect of guns on the health of their patients.Use this article to:Watch the video of the program with your learners. Stop the video after the presentation of each clinical scenario and ask your learners how they would approach the situation.Ask your learners whether they agree that firearm injury in the United States is a public health issue.Review the policy recommendations from the American College of Physicians for reducing firearm injury. Ask your learners to discuss whether they agree that physicians have a role in reducing firearm injury. If so, what is that role?Cardiac AmyloidosisAmyloidosis is a pathologic and clinical condition resulting from the accumulation of misfolded proteins in tissues. Extracellular deposition of amyloid fibrils in the myocardium leads to cardiac amyloidosis, which is often overlooked as a cause of restrictive cardiomyopathy. Cardiac amyloidosis was previously believed to have a poor prognosis, but recent advances in diagnosis and treatment have emphasized the importance of early recognition and changed management of this important and often underrecognized clinical condition. This review provides an overview of cardiac amyloidosis and summarizes current screening, diagnosis, evaluation, and treatment options.Use this article to:Discuss the presentation of cardiac amyloidosis.Ask your learners if they have any patients with cardiac amyloidosis. How was it diagnosed?Review the complications of untreated cardiac amyloidosis.Review the available therapeutic strategies for treating cardiac amyloidosis.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Current IssueMarch 2023Volume 176, Issue 3 ePublished: 21 March 2023 Issue Published: March 2023 Copyright & PermissionsCopyright © 2023 by American College of Physicians. 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